Wednesday, January 30, 2008

Next Big Thing in Medicine: Help for Spinal Cord Injuries and Quicker Healing Wounds

Researchers are looking for the next big thing in medicine, and they're getting close. One group hopes to drastically change the outcome for people with spinal cord injuries. Another’s discovery will heal wounds better and faster.

Cholesterol-lowering drugs called statins have been studied to help everything from multiple sclerosis to Alzheimer's. And soon, they could help people with devastating spinal cord injuries.

After a spinal cord injury, inflammation cuts off blood flow to the spine, making the injury that much worse. When researchers gave newly paralyzed rats statins, they not only improved, they actually started walking again.

"By using statins to shut off some of those active processes that happen in inflammation that have nothing to do with the cholesterol lowering ability of the drug, you protect the cells from dying," said Dr. Bernard Maria, pediatric neurologist.

Another group of researchers is on the verge of a breakthrough that will make healing cuts, diabetic wounds and even war injuries a whole lot easier.

"The idea of this technology is to modulate the scarring response so that we shift the balance from scarring towards regeneration," said biologist Guatam Ghatnekar Ph.D.

Doctor Ghatnekar created a substance based on a naturally-occurring protein in the body. In a recent animal study, it reduced scarring by 50-percent and healed wounds twice as fast.

A gel, like this inactive one, will be applied directly to wounds.
It can also be injected internally, which would mean less scarring and faster healing for brain, heart, even spinal cord injuries.

And they're well on their way to becoming medicine's next big thing.

Human trials on the use of statins to treat spinal cord injuries are expected to start early next year. Since statins are already FDA approved for lowering cholesterol and the safety of them is well known, doctors are forging quickly ahead. Clinical trials on the wound-healing gel began late last year.

By Becky Ogann
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Thursday, January 10, 2008

China Offers Unproven Medical Treatments

They're paralyzed from diving accidents and car crashes, disabled by Parkinson's, or blind. With few options available at home in America, they search the Internet for experimental treatments — and often land on Web sites promoting stem cell treatments in China.

They mortgage their houses and their hometowns hold fundraisers as they scrape together the tens of thousands of dollars needed for travel and the hope for a miracle cure.

A number of these medical tourists claim some success when they return home:

Jim Savage, a Houston man with paralysis from a spinal cord injury, says he can move his right arm. Penny Thomas of Hawaii says her Parkinson's tremors are mostly gone. The parents of 6-year-old Rylea Barlett of Missouri, born with an optical defect, say she can see.

But documentation is mostly lacking, and Western doctors warn that patients are serving as guinea pigs in a country that isn't doing the rigorous lab and human tests that are needed to prove a treatment is safe and effective.

Noting the lack of evidence, three Western doctors, undertook their own limited study. It involved seven patients with spinal cord injuries who chose to get fetal brain tissue injections at one hospital in China. The study reported "no clinically useful improvements" — even though most patients believed they were better. Five developed complications such as meningitis.

Experts in the West have theories about why some people think they've improved when the evidence is thin. Some are often getting intensive physical therapy, along with the mysterious injections; the placebo effect may also be a factor.

John Steeves, a professor at the University of British Columbia who heads an international group that monitors spinal cord treatments, has another theory. Some patients may be influenced by the amount of money they paid and the help they got from those who donated or helped raise money.

"Needless to say, when they come back, what are they going to report to their friends and neighbors? That it didn't work?" said Steeves. "Nobody wants to hear that."

He and other experts have written a booklet advising patients who are considering such treatments.

Western doctors discourage their patients from seeking such treatments. They note that it's impossible to gauge the safety and effectiveness of the treatments, or even know what's in the injections put into brains and spinal cords.

Patients and their families say they accept those risks. They simply don't have time to wait for more conclusive evidence. For many, the trip to China is a journey of hope.

"It's one of the only games in town," said Savage, 44, a lawyer who suffered severe spinal cord injuries after a canoe trip 25 years ago.

Savage spent 2 1/2 months in late 2006 and early 2007 at a hospital in the southern China city of Shenzhen to get what he was told were stem cell injections in his spine from umbilical cord blood. He made the arrangements through Beike Biotechnology Co., which offers the treatments at a number of hospitals in China.

Afterward, Savage said he was able to move his right arm for the first time since his diving accident; a video made at the hospital appears to show slight movement. He also said he noticed greater strength in his abdomen and more sensation on his skin.

Just how many foreigners like Savage are coming to China for treatment isn't known; and China is only one of several countries where such techniques are being offered.

Many Chinese doctors don't wait for results of rigorous testing before treating patients and they offer what they say are stem cell or other cell treatments to those willing to pay.

What is known about the procedures being performed comes from material on their Web sites or from patients who give detailed accounts of their visits. Little has been published in scientific journals for other doctors to scrutinize.

The use of stem cells for treatments isn't new. For decades, doctors around the world have been using adult stem cells from blood and bone marrow — and more recently from umbilical cord blood — to treat cancers of the blood like leukemia and lymphoma and blood diseases like sickle cell anemia.

Scientists have been exploring whether such adult stem cells and other cells such as those from the retina or fetal brain tissue could be used to replace cells lost because of injury or disease. And they are trying to figure out if there's a way to stimulate the body's own stem cells to make repairs.

But those strategies are still being investigated in the lab in animals; there have been very limited tests in people.

Whether any clinics in China are using the more controversial embryonic stem cells — doctors in some other countries claim to be — isn't clear. These stem cells are taken from days-old embryos. They can develop into all types of cells, but research into their usefulness is in early stages.

Patients seek out these unproven treatments after hearing about them from other patients, patient groups or Web sites for the medical companies. The patients' stories posted on the Internet usually tell of some kind of improvement from the treatments — slight movements in arms or legs, fewer spasms or tremors, a feeling of sensation, an ability to sweat.

Chris Hrabik, 21, has been disabled since a 2004 car crash left him with limited use of his hands and legs. His father took out a second mortgage on their Oak Ridge, Mo., home to help pay for $20,000 worth of stem cell injections at a Beike facility in China.

More than a year after returning home, Hrabik says he has nearly complete use of his left hand, with improvement in the right. He can work on his customized 1993 Nissan 240SX, a modified number complete with hand controls and racing seats.

He said he was able to move his left fingers within days of that first injection of umbilical cord stem cells into his spinal cord. There's been little progress since he left China, but he called the incremental changes significant.

"I just wanted something back, no matter what it was," said Hrabik, who attributes some of the changes to the physical therapy that he had in China.

Beike founder Sean Hu, who returned from abroad in 1999 with a doctorate in biochemistry, said the company has treated more than 1,000 patients, including 300 foreigners from 40 different countries. The only side effects have been slight fevers and headaches among a small percentage of patients, according to Hu.

He said patients with trauma injuries experience the most dramatic improvements; those with degenerative diseases such as ALS, also known as Lou Gehrig's disease, tend to improve initially but then slide back to their former condition within months.

"Patients shouldn't have their expectations too high," Hu said. "For patients to think they can walk again may be too much at this stage," he said.

He's now seeking venture capital to expand his web of treatment centers, labs and doctors and adapt proprietary techniques from researchers overseas.

"There is real potential here for China to take the lead in stem cells," Hu said.

Also offering treatments is Tiantan Puhua in Beijing, a joint venture between Asia's largest neurological hospital and an American medical group. Tiantan's sunny, sparkling rooms are a far cry from the dour facilities and staff at most Chinese hospitals. Diseases treated there range from stroke and spinal cord injuries to cerebral palsy and ataxia, a rare neurological condition that can cause slurred speech.

The hospital says its stem cell injections are combined with daily, three-hour doses of intravenous drugs designed to stimulate production of the patient's own stem cells. Physical rehabilitation and Chinese medicine are also part of the plan. A standard two-month course of treatment costs $30,000 to $35,000.

"We want to see actual improvements," said Dr. Sherwood Yang, head of the hospital's management team. "We are giving them another option at the highest level of safety."

Yang contends that 90 percent of patients show some results, with the rest suffering disabilities that are too far advanced to respond to treatment.

"We are making no promises," he added. "It's impossible to say exactly how any given patient will respond."

Western experts point to the lack of documented evidence that cell treatments have any benefit for spinal cord injuries or degenerative diseases like Parkinson's.

"All of us in the so-called Western world, if there was something valid, we'd be the first to be offering it," said Steeves, the Canadian professor and director of the International Collaboration on Repair Discoveries, known as ICORD.

Three other experts were involved in the study that found no improvement in the seven spinal cord injury patients who went for fetal brain tissue injections in China. The patients were evaluated before and after their surgery.

The doctors stressed their observations were no substitute for a larger, more strict investigation.

"People are looking for a cure," said Dr. Bruce Dobkin, a neurology professor at the University of California, Los Angeles, School of Medicine, one of the study's authors. "They may come to do something based more on a gut feeling. It's like looking for a religious miracle."

Along with the patients' booklet of advice about exploring experimental treatments, Steeves and other researchers have drawn up a set of guidelines on how to do research in spinal cord injuries. Another researcher, Dr. Wise Young of Rutgers University, is assembling a network of Chinese medical centers and universities to train researchers and conduct studies that meet international standards.

Dr. Michael Okun, medical director of the National Parkinson Foundation, said his group discourages patients from seeking out experimental treatments unless they're being done under the most rigorous research protocols.

"Stem cell therapy ... is a really interesting area that has a lot of promise for therapeutic approaches. But we're just not ready to be putting stem cells into people's brains at this point in time," said Okun.

But such warnings don't dissuade people like Penny Thomas of Captain Cook, Hawaii. She sought treatment for Parkinson's disease at Tiantan, where doctors drilled into her skull and injected what she was told were cells from a donor's retina. One year later, she said her tremors are almost gone and her medication has been cut to one-half of a single pill.

"I have no regrets and would do it all over again if need be," said Thomas, 53.

So would the parents of Rylea Barlett of Webb City, Mo. The family raised nearly $40,000 from friends and neighbors to spend a month in China at a Beike facility last summer, hoping treatments would cure their daughter's blindness. The child was born with an optic nerve disorder.

Dawn Barlett said her daughter responded to lights shone in her eyes within a week after the first of a series of five stem cell injections and can now make out blurry images on TV.

"She had no vision whatsoever before we left," the mother said. "There was no hope otherwise."

The girl's optometrist, Larry Brothers, said: "It truly is a miracle."

But when pressed for details, he said he detected "subtle differences" in Rylea's optic nerve after her return from China. Asked if he would characterize her progress as incremental, he said that "might be too optimistic."

Associated Press Writer Alan Scher Zagier reported from Missouri; AP writer Stephanie Nano in New York also contributed to this report.
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Cells Communicate After Spinal Cord Injury

The human central nervous system can reorganize itself and follow new pathways to restore cellular communication after spinal cord damage, a U.S. study found.

Lead author Dr. Michael Sofroniew of the David Geffen School of Medicine at University of California, Los Angeles, said that until now, doctors believed the only way for injured patients to walk again was to regrow the long nerve highways linking the brain and base of the spinal cord.

"Imagine the long nerve fibers that run between the cells in the brain and lower spinal cord as major freeways," Sofroniew said in a statement. "When there's a traffic accident on the freeway, what do drivers do? They take shorter surface streets. These detours aren't as fast or direct, but still allow drivers to reach their destination."

Using a mouse model, Sofroniew and colleagues blocked half of the long spinal cord nerve fibers in different places and on each side, but they left untouched the spinal cord's center.

"When spinal cord damage blocked direct signals from the brain, under certain conditions the messages were able to make detours around the injury," Sofroniew said.

The findings are published in the journal Nature Medicine.
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Tuesday, January 08, 2008

Scientists Able to Get Mice with Spinal Injuries to Walk

Scientists conducting research have been able to gain fresh insights into how partial mobility is possible despite spinal injuries. The research, conducted on mice with spinal injuries could provide a totally different approach to restoring mobility, even if it is partial, in patients who have suffered similar injuries.

Scientists conducting research have been able to gain fresh insights into how partial mobility is possible despite spinal injuries. The research, conducted on mice with spinal injuries could provide a totally different approach to restoring mobility, even if it is partial, in patients who have suffered similar injuries.

In the study, mice were inflicted with spinal injuries in the laboratory. Over a period of two to two and a half months (eight to 10 weeks), the mice were able to walk again, though not as fluently as they used to before the injuries.

The study involving the mice highlighted the fact that after a spinal cord injury, the brain and the spinal cord had the ability to reorganize their functioning and re-establish the communication network needed at the level of the cell to execute the task of walking.

Scientists said after the mice suffered from the partial spinal cord injuries, the neural networks in the brain and the spinal cord reorganized themselves. The reorganization was done in such a way that though the long and continuous neural highways transmitting impulses between the brain and the center for walking located in the lower regions of the spinal cord were broken, the mice were still able to walk.

Researchers are quite excited about the new findings. As Dr. Michael Sofroniew, neurobiology professor at the University of California Los Angeles’ David Geffen School of Medicine and lead researcher put it, “This is not the end of a story. This is the beginning of a story.”

Dr. Sofroniew said the research team was able to identify a mechanism that aided the functionality recovery from partial spinal cord injuries that no one knew about earlier. He said there was still work to be done, and that scientists now could focus on understanding this mechanism better so they would be able to know how to make better use of it.

Dr. Sofroniew said they could achieve this by undertaking the right approach to rehabilitation therapy and also determining how to stimulate this alternative network. The research is almost revolutionary as so long, scientists were of the opinion that the only way to get a person with a spinal cord injury to walk again was to have the long neural highways grow back and connect the brain to the spinal cord base.

The spinal cord basically passes through the neck of a person, down the back. It transmits messages between the brain and the different parts of the body. Any serious injury to the spinal cord, as in a car accident, can sever the long neural highways, causing the patient to be paralyzed. So far, scientists had not been able to cure paralysis of this kind.

The new research shows that when the damage to the spinal cord causes the neural highways to break down and stop messages transmitted from the brain from reaching the designated parts, it was possible for the messages to find alternative ways to reach the destination.

For instance, if the instruction from the brain was to move the leg, as in the case of walking, it would not go over the neural highway; instead, it would travel over an alternate network consisting of a number of shorter connections to ensure the message from the brain reached the legs.

Dr. Sofroniew said the situation was somewhat akin to a traffic situation. If there is a jam on the freeway, one could get on to interconnected and shorter side roads to circumvent the jam and reach the destination. That was how it was in the case of message transmission in the laboratory mice, he said.

During the research, the team shut down half the neural fibers on either side of the spinal cord without disturbing the center. The center has a series of interconnected neural passages to send and receive information between the top and the bottom of the spinal cord.

In the next step, the researchers blocked the short passages as well, and the paralysis came back, confirming the messages had earlier gone to their destination over these shorter networks, which had been earlier left open.

The next step, researchers say, is to find out how to enable the spinal cord nerve cells to develop and grow around a specific injury site so the brain can work with these cells instead and ensure there is no paralysis.

The team of scientists conducting the research has published its work in the journal Nature Medicine.

by Daisy Sarma

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Saturday, January 05, 2008

Join NSCIA for Free by January 15th to Help People with SCI

Medtronic, a leader in medical technology, has offered to donate $5 for every person who signs up as a member of the National Spinal Cord Injury Association (NSCIA) before January 15th!

Best of all, individual membership in the NSCIA is FREE!

The NSCIA has helped to improve the quality of life for people with spinal cord injuries and diseases since 1948. NSCIA advocates for best practices and public policies that affect people with SCI, and their families and service providers. Their 40 Chapters and Peer Support Groups provide a vital lifeline of information and support to more than 1,000,000 people living with SCI.

Members receive a variety of benefits that are not available to the general public, primary among them our bi-monthly publication, SCI Life, filled with issue-driven articles and news of interest to the SCI community and SCI e-news, our monthly member newsletter.

To learn more about all the benefits available to members, visit the NSCIA at

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